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a�3aso-oozo City of Zephyrhilis Fire -� 9���-/ 7%�/ Fax <br /> Permit Application � � ��> <br /> Date Received � Phone Contact for Permit � 9 � e y�y <br /> z � �� �� 7 � <br /> Owner's Name ✓ /" /L/ L� Owner's Phone Number <br /> Owner'sAddress l/ p f` s�C� �9� �Cr �� 3l <br /> Fee Simple Titleholde Nam Titleholder Phone Number d/ L�J �racFj� <br /> Fee Simple Titleholder Addres — - <br /> ..R"�S',-v [ iN.%MC S ^3R," .�� °.�sW '���•:iY�'IE.� .. � `-':�T'fR�;:eQ'�,-�; <br /> Job Address i/ � Lot # � <br /> Sub Division � w� � �/' arcel # = �—,'2 � p � .-,�70D — <br /> ' r S�', ^s" _ _ . _ _ , . . _ , . : asx*��s9•:s«�z."'+i%,'�+"�'_ - m.... - ,•,�__ - .�'.°+:7:�m . . .. �'+A�' �.. _ 3°."'..:rwr�a.�a�'!'�'s.. xa�.� <br /> a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL 'I7`�f—�l�ces of Assembly-ANNU <br /> �y emi �n er ��' � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Ins lations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> � , t.y,��*z>,.,r 's�:,�+✓+:�,a�.« _ ,;- ,+h: . �`s^:!c:�.��R.+��', K. . .:�.r. a_F._ .�.�.,.., ....-.,�� as�;.a�:. _�.� , <br /> _��r.x��_;a:?SS;�:a�, - =� ..,*;.� <br /> Contractor 1 / Company �i�/ �j� <br /> Signature I/ Registered / N Fee Current / N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> i <br /> Directions: <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />